# SCRIMED Omega Platform Audit Brief Status: omega-platform-audit-control-plane-active Updated: 2026-06-29 Products audited: 31 Audit lenses: 12 Total checks: 372 Average readiness score: 61 Controlled gaps: 158 Blocked before production: 82 ## Operating Boundary SCRIMED Omega Platform Audit is a no-PHI, no-live-care, readiness-only engineering control plane for product discovery, audit findings, upgrade lanes, and proof routing. It does not authorize PHI processing, live clinical care, autonomous diagnosis, autonomous treatment, autonomous prescribing, autonomous billing, payer submission, EHR writeback, production connector activation, public API SLA, legal advice, accounting advice, tax advice, audited financial reporting, securities material, regulatory approval, HIPAA certification, SOC 2 certification, HITRUST certification, FDA clearance, ONC certification, security certification, accessibility certification, or buyer release. ## Authority - Audit authority: readiness-control-only - Data boundary: synthetic-metadata-and-no-secret-only - PHI authority: not-authorized-production-phi - Clinical care authority: not-authorized-live-care - Billing authority: not-authorized-final-billing-or-payer-submission - Connector authority: not-production-connector-approved - Certification authority: not-certified-readiness-only - Security certification: not-security-certified - Release authority: not-buyer-release-approval ## Audit Lenses - architecture: Is the product modular, domain-bounded, and connected to shared SCRIMED trust, context, workflow, and evidence layers? Minimum standard: Owned module boundary, explicit routes, typed data contract, proof route, and no duplicate runtime. Fail-closed boundary: No production workflow can launch from an undocumented or ownerless architecture surface. - technical-debt: Are gaps, duplicated concepts, missing owners, and temporary workarounds visible and scheduled for resolution? Minimum standard: Known debt has owner, severity, workaround, graduation gate, and test or smoke coverage. Fail-closed boundary: Temporary controls cannot become informal approval. - performance: Does the product have a latency, batching, caching, queueing, and cost plan appropriate for its workflow? Minimum standard: Latency class, expected payload size, async path, cache policy, and degradation path are defined. Fail-closed boundary: No unlimited usage, SLA, or trillion-scale claim without measured production evidence. - security: Does the product enforce least privilege, AAL2 where protected, audit logging, secret hygiene, and tool authorization? Minimum standard: RBAC/AAL2 boundary, token redaction, audit route, denied data classes, and incident owner are visible. Fail-closed boundary: No protected action executes without authenticated, authorized, logged human authority. - clinical-safety: Does the product avoid autonomous clinical authority while retaining uncertainty, evidence, citations, and human review? Minimum standard: Clinical risk class, human signoff, refusal path, evidence source handling, and hard stops are defined. Fail-closed boundary: No autonomous diagnosis, treatment, triage, prescribing, routing, or signed clinical documentation. - accessibility: Can the route be navigated, scanned, and reviewed without hidden critical actions or unsupported accessibility claims? Minimum standard: Primary route exists or has a planned route, copy is scannable, and certification claims remain blocked. Fail-closed boundary: No WCAG, VPAT, or Section 508 claim without qualified review. - scalability: Does the product have a tenant, queue, worker, storage, cost, and multi-region readiness path? Minimum standard: Tenant boundary, async lane, storage class, scale owner, and rollout plan are documented. Fail-closed boundary: No managed-service or public-scale commitment without staffing, monitoring, and rollback evidence. - maintainability: Is the product built from reusable SCRIMED primitives instead of one-off logic? Minimum standard: Uses shared route, summary, brief, proof, audit, and boundary patterns. Fail-closed boundary: No new product may bypass shared TrustOS, AgentOS, QA, and boundary controls. - reliability: Does the product have fail-closed behavior, health checks, retry or fallback posture, and smoke coverage? Minimum standard: At least one deterministic contract check or documented smoke path exists before launch language expands. Fail-closed boundary: No buyer proof claim without a passing smoke, retained evidence, or explicit limitation. - user-experience: Can the target buyer understand value, current boundary, next action, and proof path quickly? Minimum standard: Clear buyer, trigger, outcome, proof route, action, and boundary language. Fail-closed boundary: No sales language may imply authority beyond the current gated state. - developer-experience: Can engineers test, extend, and verify the product without secrets or production data? Minimum standard: Typed source, no-secret fixtures, contract check, and local build compatibility. Fail-closed boundary: No test fixture may contain PHI, secrets, production credentials, or live patient data. - compliance: Are legal, privacy, security, regulatory, billing, reimbursement, and regional claims bounded? Minimum standard: Blocked claims, approval gates, and qualified-review owners are visible. Fail-closed boundary: No certification, regulatory, reimbursement, or legal conclusion is claimed by this software layer. ## Product Coverage - SCRIMED OS (implemented-surface, operating-system, risk high, score 78): Unified operating layer across AgentOS, Atlas, TrustOS, proof packets, and release controls. Gap: Needs one authoritative product registry that keeps every product in the same audit and upgrade loop. Next: attach Omega audit to product console; expand route smoke coverage; add progressive delivery register Routes: /hub, /product, /production-architecture, /healthcare-intelligence-os - Sanar AI (mapped-capability, clinical-ai, risk critical, score 52): Can plug into AgentOS and TrustOS as a review-gated clinical assistant lane. Gap: Needs specialty-specific eval packs and clinical governance signoff before protected activation. Next: add Sanar specialty eval pack; define refusal policy; map clinician signoff workflow Routes: /agents, /pilot-workspace/access, /strategic-intelligence - MyVitals AI (future-roadmap, patient-engagement, risk high, score 36): Fits SCRIMED's patient engagement and population-health roadmap. Gap: No device ingestion, consent, escalation, or patient notification authority is implemented. Next: create synthetic RPM fixture set; define consent ledger; design human escalation queue Routes: /healthcare-intelligence-os, /health-records, /clinical-production-readiness - DocuTwin (implemented-surface, documentation, risk high, score 78): Existing module, fixtures, contracts, and result-validation surfaces. Gap: Needs ambient capture integration and specialty-specific note evals before clinical use. Next: add documentation scorecards; extend missing-data tests; map clinician signoff states Routes: /modules/docutwin, /workflows, /synthetic/fixtures, /workflows/results - Ambient Scribe (mapped-capability, documentation, risk high, score 56): Mapped beyond transcription into documentation, coding, prior auth, education, and follow-up planning. Gap: Needs audio consent, local speech, specialty templates, and signed-note authority gates. Next: add ambient synthetic transcript evals; define consent and retention controls; add signoff state machine Routes: /evaluation, /healthcare-intelligence-os, /competitive-intelligence - CareExplain (mapped-capability, patient-engagement, risk high, score 56): Pairs naturally with TrustOS and QA Claim Guard for safe explanatory drafts. Gap: Needs multilingual readability evals and patient-communication approval queues. Next: add multilingual education scenarios; add readability scorecards; link to client onboarding drafts Routes: /pilot-workspace/access, /healthcare-intelligence-os, /qa-claim-guard - Perfect Chart (mapped-capability, documentation, risk high, score 56): Strong alignment with source attribution, validation, and no-final-billing boundaries. Gap: Needs specialty chart-completeness benchmarks and EHR sandbox contracts. Next: build synthetic chart gap suite; define chart-signature hard stop; map RCM reviewer handoff Routes: /health-records, /workflows/results/validation, /pilot-workspace/access - Clinical Copilot (implemented-surface, clinical-ai, risk critical, score 70): Existing route plus strong clinical authority and TrustOS guardrails. Gap: Needs adversarial clinical robustness lab coverage before protected activation. Next: add missing-data clinical evals; add contradiction checks; map specialty governance owners Routes: /modules/clinical-copilot, /clinical-authority-readiness, /trust-os - Contact Center AI (mapped-capability, operations, risk medium, score 62): Strong fit with onboarding, scheduling, and human-reviewed communication packets. Gap: Needs telephony integration plan, consent controls, and escalation handling. Next: define call transcript fixture policy; add escalation queue; map scheduling API gates Routes: /client-onboarding, /service-delivery, /sales-operations - Patient Education (mapped-capability, patient-engagement, risk high, score 56): Can be safely sold as reviewed education drafting without patient-specific medical advice. Gap: Needs formal content review queue and multilingual clinical safety checks. Next: add education content registry; add multilingual scenarios; add source citation verification Routes: /healthcare-intelligence-os, /qa-claim-guard, /client-onboarding - TrialCore (implemented-surface, research, risk high, score 74): Existing module and synthetic workflow coverage. Gap: Needs protocol ingestion governance and no-patient-outreach controls. Next: add protocol source registry; add contradiction detection; map IRB/research governance handoff Routes: /modules/trialcore, /workflows, /synthetic - OncoID (future-roadmap, clinical-ai, risk critical, score 32): Strategically strong for oncology, trials, and evidence-grade workflows. Gap: Requires qualified oncology governance, genomic privacy controls, and specialty evals. Next: create oncology synthetic suite; add evidence grading; define genomics data boundary Routes: /healthcare-intelligence-os, /clinical-production-readiness, /global-certification-readiness - Trust Engine (implemented-surface, trust-governance, risk medium, score 80): Core differentiator tying evidence, confidence, risk, and review status together. Gap: Needs immutable external audit sink and tamper-evidence hardening. Next: add immutable log adapter interface; add trust score regression tests; expand claim guard coverage Routes: /trust-os, /trust-center, /qa-evidence - Trust Dashboard (implemented-surface, dashboard, risk medium, score 78): Buyer-visible trust posture without overclaiming certification. Gap: Needs role-specific dashboard filters and protected evidence vault UX polish. Next: add trust dashboard route grouping; add procurement filter model; add evidence expiration alerts Routes: /trust-center, /trust, /pilot-workspace/access - Clinical Intelligence Platform (implemented-surface, clinical-ai, risk critical, score 70): Broad healthcare AI OS mapping with clinical safety boundaries. Gap: Needs continuous clinical robustness lab implementation and reviewer queue. Next: add adversarial clinical eval route; add reviewer queue contract; connect source intelligence Routes: /healthcare-intelligence-os, /clinical-production-readiness, /clinical-authority-readiness - Imaging Platform (future-roadmap, imaging, risk critical, score 32): Can align MONAI, nnUNet, SwinUNETR, SegResNet, TensorRT, edge inference, and GPU scheduling in a governed roadmap. Gap: No imaging model runtime, DICOM image store, GPU scheduler, or radiologist validation is implemented. Next: create imaging architecture contract; add DICOM synthetic fixtures; define GPU deployment gate Routes: /healthcare-intelligence-os, /production-architecture, /clinical-production-readiness - Referral Intelligence (mapped-capability, operations, risk high, score 56): Clear commercial wedge for access operations and specialty routing. Gap: Needs deterministic ReferralOS workflow engine and wait-time model governance. Next: add referral workflow contract; add leakage dashboard model; define scheduling approval gate Routes: /pilot, /product, /healthcare-intelligence-os - Prior Authorization (implemented-surface, payer-rcm, risk high, score 76): Existing agent and standards readiness surfaces. Gap: Needs payer-specific policy source authority and transaction testing. Next: add prior auth synthetic packet suite; define payer policy registry; add no-submission smoke Routes: /agents/prior-authorization-agent, /interoperability, /health-records - Revenue Cycle (implemented-surface, payer-rcm, risk medium, score 78): Strong buyer value with explicit no-final-billing and no-guarantee boundaries. Gap: Needs coding expert review queue and X12/payment workflow separation. Next: add denial appeal evals; define coding review status; add reimbursement no-guarantee tests Routes: /agents/revenue-cycle-agent, /enterprise-business-ops, /growth-engine - Payer Intelligence (mapped-capability, payer-rcm, risk medium, score 60): Differentiated PayerIQ evidence engine opportunity. Gap: Needs policy-source registry and payer/trading-partner approval gates. Next: create PayerIQ registry; add policy freshness checks; add RCM no-submission contract Routes: /competitive-intelligence, /health-records, /enterprise-business-ops - Population Health (mapped-capability, clinical-ai, risk high, score 56): Maps into buyer demand for quality, access, and value-based care operations. Gap: Needs privacy, equity, aggregation, consent, and outreach governance controls. Next: add aggregate synthetic datasets; define equity audit lens; create outreach approval gate Routes: /healthcare-intelligence-os, /health-records, /clinical-production-readiness - Clinical Research (mapped-capability, research, risk high, score 56): Can become a chained research pipeline with evidence ranking and contradiction detection. Gap: Needs official literature connectors, citation verification, and research governance queue. Next: add research pipeline contract; add citation verification tests; define trial matching refusal rules Routes: /modules/trialcore, /healthcare-intelligence-os, /global-reach - Provider Dashboard (future-roadmap, dashboard, risk high, score 36): Can unify review-gated clinical and administrative tasks. Gap: Needs authenticated provider identity, task queues, and role-specific UI. Next: design provider task model; add role-based dashboard route; connect human review queue Routes: /product, /clinical-production-readiness, /pilot-workspace/access - Executive Dashboard (implemented-surface, dashboard, risk low, score 84): Already strong as a whole-company command view. Gap: Needs drill-down ownership, trend snapshots, and board-ready export controls. Next: add trend snapshot ledger; add board packet export; map owner-level remediation Routes: /company-assessment, /product, /launch-readiness - Admin Console (protected-gated, operations, risk medium, score 68): AAL2 tenant-admin path now has protected smoke proof. Gap: Needs full tenant-admin UX, invitation lifecycle, and access-review automation. Next: add admin console route; add invitation workflow; add access review reminders Routes: /pilot-workspace/access, /qa-manual-execution-console, /limitations-workarounds - Patient Portal (future-roadmap, patient-engagement, risk critical, score 32): Clear future digital front door value. Gap: Requires identity, consent, PHI authorization, accessibility review, and clinical escalation governance. Next: define patient identity architecture; add consent tracking model; add accessibility audit plan Routes: /healthcare-intelligence-os, /client-onboarding, /clinical-production-readiness - SCRIMED University (mapped-capability, education, risk low, score 64): Can reduce onboarding friction and partner delivery variability. Gap: Needs curriculum registry, content review, and role-based learning paths. Next: create curriculum map; add training proof route; define reviewer workflow Routes: /global-reach, /service-delivery, /client-onboarding - Atlas Platform (implemented-surface, platform, risk medium, score 80): One of SCRIMED's strongest enterprise differentiators. Gap: Needs external evidence-room connectors and regional deployment proofs. Next: add evidence adapter registry; add sovereign deployment checklist; connect to Omega registry Routes: /atlas, /global-reach, /deployment-profiles - Mobile Applications (future-roadmap, platform, risk high, score 36): Clear enterprise value for clinician mobility and patient engagement. Gap: No mobile codebase, offline sync model, device security plan, or app-store compliance path. Next: define mobile architecture; add offline data policy; map push notification hard stops Routes: /production-architecture, /enterprise-scalability, /clinical-production-readiness - Agent Marketplace (mapped-capability, platform, risk medium, score 60): AgentOS gives a credible foundation for governed healthcare agents. Gap: Needs MCP gateway, tool-level authorization, revocation, and partner review process. Next: define marketplace submission schema; add permission manifest; add sandbox execution contract Routes: /agents, /governance-packs, /production-architecture - Internal Operations Platform (implemented-surface, operations, risk low, score 84): Strong operational control plane already exists. Gap: Needs recurring automation, alerting, and dashboard trend retention. Next: add operations score history; define alert thresholds; connect to release-control checklist Routes: /operational-efficiency, /service-reliability, /limitations-workarounds ## Implementation Lanes - Clinical Robustness Lab (p0): Create adversarial, missing-data, conflicting-data, abbreviation, noisy-note, wrong-unit, multilingual, incomplete-record, temporal-inconsistency, and hallucination-risk evals for every clinical product. Applies to: Sanar AI, Clinical Copilot, DocuTwin, Ambient Scribe, CareExplain, Perfect Chart, TrialCore, OncoID Pattern: synthetic fixtures, evidence cards, human review queues, regression scorecards - Agent Runtime and MCP Gateway (p0): Standardize agent identity, scoped permissions, tool manifests, OAuth/OIDC handoff, audit logs, revocation, replay traces, and human approval gates. Applies to: Agent Marketplace, SCRIMED OS, Admin Console, Internal Operations Platform Pattern: agent registry, tool registry, permission manifest, AAL2 protected execution, audit event stream - Private and Edge AI Architecture (p1): Prepare hospital-deployable local inference, local speech, local vision, local imaging, FHIR gateway, private knowledge graph, offline mode, and no-PHI-egress controls. Applies to: Imaging Platform, Ambient Scribe, Mobile Applications, Atlas Platform Pattern: edge gateway, local model route, FHIR facade, offline sync ledger, data residency policy - Payer, Referral, and Revenue Engine (p1): Convert prior auth, referral intelligence, payer intelligence, and revenue cycle into deterministic review-gated workflows with policy evidence, queue states, ROI measurement boundaries, and no-submission controls. Applies to: Prior Authorization, Referral Intelligence, Payer Intelligence, Revenue Cycle Pattern: deterministic workflow contracts, policy source registry, review queues, finance methodology gates - Observability and Progressive Delivery (p1): Attach traces, cost, latency, model route, confidence, reviewer outcome, hallucination risk, PHI exposure risk, feature flags, canaries, and rollback plans to product releases. Applies to: SCRIMED OS, Trust Engine, Clinical Intelligence Platform, Internal Operations Platform Pattern: trace envelope, feature flag registry, canary scorecard, rollback owner, release health checks - Enterprise Infrastructure, IaC, and Disaster Recovery (p2): Move from app-level readiness into Docker, Kubernetes, Terraform, queue workers, Redis, object storage, backups, restore validation, SBOM, and disaster-recovery drills. Applies to: SCRIMED OS, Atlas Platform, Admin Console, Internal Operations Platform Pattern: container contract, worker pool, IaC plan, backup validation, SBOM and dependency scan ## Hard Stops - PHI introduced - live clinical care implied - autonomous clinical decision requested - production connector requested - unsupported certification claim - buyer release implied without approval - clinical validation claimed - diagnosis implied - treatment implied - reviewer missing - tool execution without permission - unscoped token - missing audit event - AAL2 bypass - PHI leaves environment without approval - local model unapproved - offline sync unencrypted - payer submission approved - coverage guaranteed - coding finalized - reimbursement guaranteed - release without rollback - unobserved protected action - model route unlogged - cost owner missing - DR claimed without restore test - SBOM missing - secret in IaC - multi-region claim without runbook ## Next Highest Impact Step Implement the Clinical Robustness Lab route and contract checks, then connect Sanar AI, Clinical Copilot, DocuTwin, Ambient Scribe, CareExplain, Perfect Chart, TrialCore, and OncoID to adversarial synthetic clinical evals with human reviewer queues.